長期使用植入性心室輔助器的重要關鍵－驅動線傷口照護

Driveline Wound Care: Key to the Long-Term Use of Implantable Ventricular Assist Devices

10.6224/JN.201908_66(4).11

黃惠群(Huei-Chiun HUANG)；王昭慧(Chao-Hui WANG)；蔡峰鈞(Feng-Chun TSAI)

左心室輔助器 ； 驅動線感染 ； 驅動線傷口照護 ； left ventricular assist device ； driveline infection ； driveline wound care

護理雜誌

66卷4期（2019 / 08 / 01）

87 - 94

繁體中文

心衰竭是一個複雜的慢性疾病，雖然已有許多新藥用來協助症狀緩解及改善生活品質，但末期心衰竭最終治療仍以心臟移植手術為主。但由於心臟捐贈有限，歐美各國多以機械循環輔助裝置來暫時替代心臟功能；植入性心室輔助器不但可減輕移植前心衰竭的症狀，亦可提高生活品質。然而，長期使用心室輔助器，最嚴重的合併症之一，即是驅動線感染，若此感染無法控制，則需要再次手術更換心室輔助器，嚴重者甚至造成死亡。因此，唯有將心室輔助器驅動線傷口照護標準化並妥善固定驅動線，才能有效降低感染率，增加病患存活率。有鑑於臺灣缺乏相關照護準則，本文係透過參考歐美各國的傷口護理規範及相關文獻，及筆者照護驅動線傷口的臨床護理經驗分享，期盼本文可提供相關護理人員臨床照護參考依據。

Heart failure is a complicated chronic disease. Although numerous new medications are used to treat and improve the quality of life of patients with heart failure, the final treatment for terminal heart failure still relies heavily on heart transplants. However, as the number of heart donations is limited, many health institutions implant mechanical assist devices to perform heart functions temporarily. These implanted ventricular assist devices help reduce heart failure symptoms and enhance quality of life. However, driveline infection is one of the more severe complications associated with these devices. If this infection is not controlled, another heart surgery will be necessary to replace the device. Severe driveline infection may even lead to patient death. An approach to care that includes driveline wound care standardization and immobilization of the driveline has been shown to effectively decrease the incidence of driveline infections and to increase the survival rate. As Taiwan still lacks the relevant clinical care standards for implantable ventricular assist device support and driveline wound care, this study introduces the relevant Western literature and the author's clinical experience related to driveline wound management. We hope that this article serves as a useful reference for related nursing care.

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